This application is in response to NIDA's program announcement, PA-03-126, "Behavioral Therapies Development Program." In Los Angeles and other West Coast cities, methamphetamine use and corresponding STD transmission behaviors are central to the continuing HIV epidemic. Methamphetamine-using gay and bisexual men (GBM) who receive medical care for HIV disease are increasingly of concern to their medical care providers due to problematic drug use behaviors, associated sexual risk behaviors, and the impact of these on their HIV disease. Development of effective behavioral drug abuse treatment for methamphetamine-abusing GBM that is delivered in HIV medical care settings represents a novel "prevention for positives" intervention. Treatment-influenced reductions in methamphetamine use in this high-risk group would: decrease drug-associated problems with HIV medication adherence (and concomitant decreases in viral load); decrease drug-associated HIV transmission behaviors with unknown or anonymous partners; and decrease likelihood of sexually transmitted infections and potential superinfection with HIV. This early therapy development application (Stage I) seeks to adapt/develop a behavioral treatment for this purpose that refines our gay culture-specific cognitive-behavioral intervention (GCBT) and incorporates evidence-based elements of interventions shown effective in increasing HIV medication adherence and decreasing HIV risk behaviors. Specific aims of this project are consistent with Phase I behavioral therapy development, i.e., to (1) conduct research on the development, refinement, and pilot testing of this behavioral therapy by adapting our existing GCBT for use with HIV-infected GBM receiving HIV medical care and evaluate the feasibility of its use when delivered in the HIV care clinic; and (2) to gather estimates of the size of the signal for this adapted therapy. The project evaluates drug use, sexual risk, and HIV medication adherence behaviors for 25 treatment-seeking methamphetamine-using HIV+ GBM and 25 methamphetamine-using HIV+ GBM non-treatment-seeking men, measured at baseline through 6- month evaluations. Effectiveness data from this research will be used to inform the continued Stage II development of this intervention.